Oli Hudson looks at what the NHS is doing to reduce health inequalities and how pharma can get involved

Tackling health inequalities has been a running feature of government health policy for decades, from the Acheson Report in 1998 to the Marmot Review in 2010.

Today, with life expectancy flatlining and COVID brutally highlighting the disparities in outcomes between some social and ethnic groups, it’s no surprise to see the challenge of reducing the health gap is back on the agenda in a big way.

There’s now a new government agency – the Office of Health Improvement and Disparities – set up to work with communities and other government departments to improve people’s health and reduce the health gap; a blizzard of national initiatives to tackle gender and racial bias in healthcare; and a concerted effort, through the Health and Social Care Bill, to put action on health inequalities at the heart of the government’s reforms.

But what does all of this signify for pharma? How does this renewed drive to reduce health inequalities affect what the customer may be looking for, and how can Industry leverage its expertise to help the NHS answer the challenge?

Let’s start by taking a closer look at how this issue plays into the NHS reforms, and (in crude terms) who is responsible for doing what.

Reducing health inequalities appears as a golden thread running through all levels of NHS business. At the highest level, one of the four strategic aims of all Integrated Care Systems (ICSs), according to NHS England’s ICS design framework, is to: ‘Tackle inequalities in outcomes, experience and access’. The Health and Care Bill will soon make this a statutory duty.

Underpinning this, Integrated Care Boards (ICBs) are required to create a five-year plan, which should set out how they will exercise this duty and will also need to publish an annual report accounting for their progress.

To help them, Integrated Care Partnerships (ICPs), which represent organisations across local authorities, the NHS and voluntary sector, are meant to develop an integrated care strategy that uses the best available evidence, while addressing health inequalities and the wider determinants which drive these equalities.

Action on health inequalities also looms large within the government’s national policy agenda, with the Health Secretary keen to make action on health ‘disparities’ his personal calling card. Hence a review is already underway on racial bias in medical equipment, a call for evidence was launched to shape a new women’s health strategy late last year and a new ten-year Cancer Strategy is also in the pipeline.

So, what’s happening on the ground? Broadly speaking, the NHS is looking at the issue through the prism of four main categories of difference: socio-economics, geography, specific characteristics and social exclusion.

The specific interventions that are put in place will vary according to need and circumstance, but there are some common themes around:

• Improving diagnostics and screening, particularly where there are communities or groups at heightened risk
• Providing more equitable access to care, including through outreach activity to support excluded groups
• Ensuring a more integrated package of care for people with multiple conditions or complex needs
• Understanding and acting on variation in outcomes during and after surgery or any other intervention.

It’s worth remembering why this matters so much to the NHS. On one level, improving care for those who aren’t currently enjoying the best outcomes is a basic question of fairness and equity.

More pragmatically though, inequalities also tend to carry a significant cost to the system – for example, if certain groups typically present later with more advanced disease or need more regular hospital care due to challenges in managing their wider health.

Changes to how services are funded reinforce this point. The switch to a blended contract – via a single system-level pot of funding – further incentivises all parts of the NHS to zero in on unwarranted variation as it means all organisations share responsibility for achieving the best possible outcomes for their populations.

Perhaps the biggest opportunity for industry is around data. Through its expertise in understanding specific conditions, its ability to identify cohorts of patients who may not be receiving the right treatment and its strength in terms of segmenting data to advise on how to stratify patients based on risk, pharma has invaluable insights that can guide the NHS as it reconfigures services and pathways to improve health equity.

Another important opportunity is around co-production and partnership. Health inequalities are often solved through collaborative action. These productive partnerships can involve pathway redesign and workforce capability building or the co-creation of public education programmes to help patients manage their own condition more effectively or tackle myths and misinformation.

This is a time when NHS customers will be particularly interested in ideas that boost population-level outcomes and reduce the long-term strain on services by focusing on untreated or under-served cohorts. But how do you start this conversation with customers?

Firstly, it’s critical that any approach is rooted in a strong understanding of the particular ICS’s strategy for dealing with health inequalities – this should be reflected in its five-year plan and, to some extent, the one-year service delivery plans that ICSs are expected to publish every April. Make sure you have fully grasped what these documents say and can frame your proposition within this strategic context.

Also, most ICSs will have a population health ‘champion’ who is leading the charge – often identifiable from board reports relating to population health management. This is typically a transformation lead or partnerships director, or the medical or clinical director, and is a crucial stakeholder. Find out what is on the champion’s agenda and think about how your proposition connects with it.

Finally, think about how your proposition can be sited and scaled appropriately within an integrated provider environment. Does it resonate with the strategic needs of local communities as set out in the Integrated Care Strategy from the ICP? How straightforward is it to operationalise? Do you have case studies that demonstrate the proof of concept? And, crucially, how do you ensure all delivery partners are engaged and onboard?

Make sure you think broadly about who needs to be engaged – as it may not be the usual suspects.

Wilmington Healthcare provides market leading data, insight and intelligence across the healthcare community. Go to wilmingtonhealthcare.com